Provider Demographics
NPI:1598704884
Name:ROSENTHAL, MICHAEL S (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-6628
Mailing Address - Country:US
Mailing Address - Phone:215-830-9991
Mailing Address - Fax:215-830-0175
Practice Address - Street 1:440 HORSHAM RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2141
Practice Address - Country:US
Practice Address - Phone:215-830-9991
Practice Address - Fax:215-830-0175
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006146L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1196513OtherCIGNA
PA04316100OtherINDEPENDENCE BLUE CROSS
PA250008704OtherUNITED HEALTHCARE
PA608837OtherHIGHMARK BLUE SHIELD
PA608837Medicare ID - Type Unspecified
PA04316100OtherINDEPENDENCE BLUE CROSS